The Miraculous Fever-Tree

by Fiammetta Rocco

  Of the charterers, thirty were women. This was unusual, though less unusual than it would have been a hundred years earlier. By the middle of the eighteenth century Lima was a thriving city. Thousands of Spaniards lived there, and with them their wives and children, as well as other European immigrants and Indians who had moved down from the Andes. Many of them intermarried with the local people, as had Martin Garcia Oas de Loyola, the great-nephew of St Ignatius, the founder of the Society of Jesus, when he wed the Inca princess Beatriz Clara Qoya at the end of the 1590s.

  The busy streets and markets may have given the impression that life was easy in Lima, but young families often struggled, and many people died young. Most of the women who had chipped in to help charter the Conde were widows, with no choice but to take up the chair at the head of the family table when their husbands died. In order to raise and educate their children, they took over their husbands’ affairs and continued to run their businesses as best they could.

  Standing on the dockside that late August day were three of the women who had helped charter the Conde, Dona Maria Josepha de Albinar, Dona Pheliziana Barbara Garzan and her friend Elena Woodlock y Grant, an Englishwoman who practised in Lima as a doctor, and who some years earlier had left Scotland with her husband, Don Juan Grant de Rufimurcus, one of the many John Grants of Rothiemurcus whose descendants still live in the Highlands today.

  The three women, especially the fabulously wealthy Dona Pheliziana, accounted for a large portion of the cargo that was being loaded on board. As the fog began slowly to lift, they stepped forward to observe their ship, lifting their jet-black skirts and letting go of the black mantillas they had held tightly across their cheeks against the wind. One by one they counted the porters carrying their loads: silver in doubloons as well as bars – nearly two and a half million pesos’ worth of bullion from the mines at Potosí – gold castellanos, sacks of fine vicuna wool, cases of cocoa, vanilla, white sugar, rich chocolate paste, leather skins and, of course, cascarilla, the Peruvian bark that the Jesuits had introduced to Europe as the newest, and by far the best, treatment for the tertian ague or the Roman fever.

  Nearly all of the ship’s two thousand libras of Peruvian bark was being loaded aboard on behalf of the three women. There would be heavy import duties to pay when it reached Spain – 10 per cent to the King, 1 per cent to the port of Cadiz, half a per cent to the prestamistas, the clearing agents, not to mention the quarter per cent offering that it was suggested should be made to la Santa Iglesia, the Holy Mother Church, but which everyone knew was a tithe that could not be refused. Yet, as a result of the success of the first small package of dried bark that Brother Salumbrino had sent to Rome in 1631, demand for cinchona was growing all over Europe. Dona Pheliziana and her friends knew that, despite the taxes, they would still make a handsome enough profit from the shipment to make all the risks worthwhile. Peruvian bark, which they bought for just under one peso a pound from the Jesuit pharmacy at San Pablo, or from other suppliers if they could find it more cheaply, could command twenty or thirty times that sum in Cadiz, and even more once it reached Rome, Amsterdam or London.

  If the bark owed its early popularity to the Jesuits at the College of San Pablo in Lima, it was another Jesuit, across the sea in Europe, who had been its biggest champion.

  Cardinal Juan de Lugo was born in Madrid in 1583, and after spending his early childhood in Seville went at the age of sixteen to the University of Salamanca to study law and jurisprudence. While continuing his studies, he became a year later a novice in the Society of Jesus, following the example of his older brother. At the age of twenty he wrote a legal treatise entitled De Justitia et Jure, which dealt with the practical problems of administering justice, and which demonstrated that he had a mind of his own and the courage to live according to his convictions rather than what his conservative seniors might dictate. De Lugo was a determined litigator who was not averse to contradicting precedent and pointing out error, and he expounded his conclusions with remarkable lucidity. The treatise, which became a landmark in the history of seventeenth-century law, might have opened many doors, and made its young author a wealthy man. But de Lugo was determined to become a Jesuit priest; and in any case, he knew that the many Jesuit centres of learning in Spain offered him the best environment in which to broaden his studies in philosophy and theology.

  De Lugo’s reputation spread, and when he was thirty-seven years old the Vicar-General of the Society of Jesus decided that he should go to Rome to teach at the Gregorian University. In 1643 de Lugo reached the age of sixty. His health, which had never been terribly robust, had been undermined during his years in the Holy City by the inevitable Roman fevers. And he felt that his austere and uneventful life was coming to its end.

  But around that time De Justitia et Jure, which had been written forty years earlier, was republished. It was dedicated to Pope Urban VIII, who was impressed by the legal brilliance of the author’s mind and his clarity of thought. Europe was exhausted by religious strife. The Thirty Years’ War was raging, and Pope Urban’s diplomats were engaged in a dozen or more other ecclesiastical disputes that had resulted from the Reformation. Men like de Lugo, with clear, visionary minds, were greatly needed in the Vatican.

  The Pope summoned de Lugo, and informed him that he was making him a cardinal. Most of the priests who jostled for influence in the curia under Pope Urban and his predecessor, Pope Gregory, who had given his nephew Cardinal Ludovico Ludovisi so much power, would have jumped at such a chance. But the ageing Jesuit knew that his vows precluded him from accepting external honours. He also knew that he could not disobey his pontiff. De Lugo resolved his dilemma by bowing his head and obeying. But he was determined that his new eminence should not change his nature, and he made his investiture the first and last ceremony he ever attended at the papal court. After it was over, de Lugo returned to his former austere way of life. He used only a few rooms in the palace that had been given him in Rome, and reduced the number of servants in his house to the minimum. Most of his cardinal’s income he gave away to charities.

  Whether or not Cardinal de Lugo would have fulfilled the Pope’s intentions for him will never be known, for seven months later, in the midsummer of 1644, Pope Urban VIII was dead. Like his predecessor Gregory XV, Urban died in July. Once again, it seemed, a papal conclave would have to be held in this most malarious of European cities during the very worst season of the year. The physicians attending the cardinals urged that the conclave be postponed until the autumn. They received the unexpected support of King Louis XIV of France, for at that moment Cardinal Guido Bentivoglio, the man many thought would become the next Pope, was far away from Rome as the Papal Nuncio in Paris. However, Pope Urban’s two Cardinal nephews were eager that their influence should prevail, and they persuaded the rest of the College of Cardinals to call the conclave at once. Bentivoglio would have no choice but to travel to Rome if he wanted to take part.

  The threat of the summer marsh fever was uppermost in the minds of the cardinals who contemplated making the journey. It seemed to many that the dreadful conclave of 1623 might be about to repeat itself. In the event, three weeks after he arrived, Cardinal Bentivoglio succumbed to the Roman fevers.

  The new Pope, Innocent X, a former Papal Nuncio in Madrid, was especially close to the Spanish cardinals, and had long been an ally of their King. Not that Cardinal de Lugo was in a position to take much notice of this at the time. Along with a number of the other cardinals who had attended the conclave he too had fallen ill with the fever, and it was many months before he felt well enough to take up his work once more.

  In 1649, five years after the election of Pope Innocent, the Vicar-General of the Society of Jesus died, and the provincial fathers from all over the world congregated in Rome to elect a new head. As a cardinal, Juan de Lugo was one of the most important men present. The congress opened on 13 December, and among the delegates who had come from as far afield as Poland, Mexico, Goa and Japan was Father Bart
holomé Tafur, the Peruvian Jesuit from San Pablo who had travelled to Rome carrying a quantity of quinine bark in his luggage and who, four years later, would become the head of the college in Lima. Cardinal de Lugo, whose brother was now with the Jesuits in Mexico, was eager to hear what St Ignatius’ followers were doing in the New World. He and Tafur shared a deep interest in theology. Moreover, the two men had already met before, when Tafur had come to Rome for the eighth general congregation of the Jesuits which began in November 1645.

  What the Spanish Cardinal needed most, though, given the recurring bouts of malaria from which he suffered, were the fresh supplies Tafur brought of cinchona bark. Among his many responsibilities, de Lugo had been appointed as the director of the apothecary at the Santo Spirito hospital, whose doctors had treated Pope Urban VIII after the terrible conclave of 1623. According to a Jesuit and naturalist, Honoratus Fabri, de Lugo had the Peruvian bark tested by a Portuguese doctor, Gabriele Fonseca, who was the new Pope’s personal physician. Unfortunately, no record of Fonseca’s trials survives. But de Lugo was eager to begin distributing the bark to the poor of the city. Within a short time, Pietro Paolo Puccerini, a lay brother in the Jesuit order who had become the director of the pharmacy at the Collegium Romanum, printed a recipe in his Schedula Romana extolling the virtues of cinchona bark as a remedy for tertian and quartan fever, and explaining how it should be used:

  This bark comes from the Realm of Peru, and is called China or real China of the fevers, which is taken for the quartan and tertian fevers that are accompanied by cold. It should be taken thus: two drachms, finely ground and sifted, three hours before the fever is due to take hold, should be made in an infusion in a glass of white wine. When the shivering starts, or when the slightest cold is felt, all of the preparation should be taken at once and the patient put to bed … For four days no other medication whatsoever must be taken. It must be used only on the advice of the physician who may consider whether it is timely to administer it.

  The drug removed the sickness ‘infallibly’, Puccerini wrote, and although a few patients suffered relapses, these were readily treated with additional doses. Puccerini treated many thousands of patients each year, and so far as he was aware, he wrote, the bark had had no bad effects in Rome, Florence or the papal states. Moreover, he wrote, the bark had been conveyed to Naples, Genoa, Milan, Piedmont, England, France, Flanders and Germany.

  Despite Puccerini’s enthusiasm, the physicians and pharmacists of the time actually knew very little about the Peruvian bark. They probably would have had great difficulty in distinguishing between cinchona, especially if it was in powder, and most of the other foul-tasting dried barks that were stored in jars on apothecaries’ shelves across Europe. The dosages they advised were based more on guesswork than on any empirical evidence; it was inevitable, sooner or later, that the wonder drug would fail to cure a case of tertian fever.

  In the autumn of 1652 the bark was administered, following the instructions of Puccerini’s Schedula Romana, to a patient of some eminence, the Archduke Leopold William of Austria, Governor of Belgium and Burgundy, who had been diagnosed as having a double quartan fever. The Archduke’s own physician, Jean-Jacques Chiflet, had not been greatly in favour of the experiment, yet he gave in under pressure from other prominent members of the court who had heard tell of the bark’s curative properties in Rome. For a while the Archduke appeared to be cured, but a month later the fever returned.

  Had the Archduke been prepared to take another dose of bark when the fever recurred, he might well have recovered. But he was not willing to, in part perhaps because his brother, the Holy Roman Emperor Ferdinand III, had sent him a letter disapproving of its use. Indeed, the Archduke was so outraged that the bark had not delivered him at once of his malady that he decided to show his royal displeasure by ordering his physician, in defiance of the Vatican, to write a book denouncing the new remedy as a fraud.

  Exposure of the Febrifuge Powder from the American World by Joannes Jacobus Chifletus, to give his full name in Latin, appeared in 1653, and was widely discussed, especially in the Protestant world, which was naturally suspicious of any remedy promoted by the Jesuits. In his account, Chiflet said that the bark merely lengthened the intervals between fevers but did not cure it; the drug was not needed in Europe, he added, for many other febrifuges were available. Moreover, he insisted it was dangerous, causing the humours to putrefy in the gall bladder, spleen, stomach and intestines, and to liquefy and spill over into adjacent organs, producing ‘prolonged and fatal diseases’.

  A prompt reply to Chiflet was published in Rome in the form of a book called Pulvis Peruvianus Vindicatus de Ventilatore Ejusdemaque Suspecta Defensio, or Vindication of the Peruvian Powder, in which the author claimed that in that same year, 1653, thousands of people in Rome had been cured of the fevers by this remedy. The book was signed with the name Antimus Conygius, a pseudonym for Honoratus Fabri, the same man who asserted that Cardinal de Lugo had had the Peruvian bark tested when it first arrived in Rome by the Pope’s personal physician.

  Cleverly defending the Jesuit order and its achievements, Fabri set out to destroy Chiflet’s arguments. The authorities Chiflet cited had lived at a time when the bark had not yet reached Rome, he said, and were therefore irrelevant. Chiflet’s interpretation of his experience was false, because it insisted that the powder had helped no one, and his reasoning was quite unsound. If the drug was unnecessary in Europe, as Chiflet maintained, there would be no need for many of the other febrifuges, such as myrrh and gentian, that he mentioned without disapproval. If Fabri so wished, he concluded, he could mention by name more than a hundred people who had benefited from the bark, including cardinals, princes, high government officials and ‘persons of religion’.

  Fabri’s rebuttal did nothing to allay the wrath of Archduke Leopold, who hurried to find himself a more eminent voice than Chiflet’s with which to shout down the Jesuits. He chose a Protestant-born physician and medical academic, Vopiscus Fortunatus Plempius, who had converted to Catholicism at the age of thirty-two, not out of conviction but in order to take up a prestigious job as Professor of Medicine at the University of Louvain, where he now enjoyed the wonderful title of ‘Rector Magnificus’. Plempius, though officially a Catholic, was a Protestant at heart; he was also by nature an archconservative.

  Some years earlier, Professor Plempius had taken pleasure in vilifying the English physician William Harvey when he published his discovery of the circulation of the blood, wondering loudly how Harvey dared to contradict the ancients. In taking on this fresh controversy, Plempius maintained that he had not understood a word of Fabri’s arguments, but that did not bother him because he did not have the least desire to do so. He had read, he wrote, the writings of Galen, Hippocrates and Avicenna, who knew how to write about medicine and who never spoke of powders, let alone powders from Peru, as remedies. He quoted three cases where the drug had failed, and made the astonishing assertion that the bark had the effect of turning sporadic attacks into daily fever. Moreover, he added, in a vicious personal attack, he refused to believe that Cardinal de Lugo was supporting the use of the new remedy, since this eminent man was known to him as a great theologian, but in no other capacity could he be described as a fount of knowledge, medical or otherwise.

  Religious bigotry played a large part in the arguments that raged about the bark’s efficacy. Cinchona had been discovered by the Jesuits, and was being openly promoted by one of their most senior members – so much so that it was being called ‘Cardinal’s powder’ or ‘Jesuit powder’. That did not please the Protestants. But there was another aspect to the arguments. The raging controversy symbolised the growing divide between the hardline medical conservatives, traditionalists who wanted to preserve the ancient doctrine of Galenic medicine at any cost, and the younger, more adventurous doctors who were slowly coming to realise that Galen, master though he may have been, was wrong about many things.

  Cinchona, more than any other drug, woul
d be crucial in overturning Galen’s teachings, which had survived for nearly two thousand years. It would change the direction of European medical thought.

  Galen, a Greek physician who began practising medicine in Rome in 162 AD, incorporated the earlier ideas of Hippocrates and the ancient theory that all matter is composed of four elements: earth, air, fire and water. Diseases were thought to be caused by an imbalance of the four humours: blood, phlegm, black bile and yellow bile. Fever was a bilecaused disorder, and was considered a disease in its own right rather than a symptom. A patient with a high fever was said to be suffering from a fermentation of the blood resulting from too much bile. When fermented, blood behaved a little like boiling milk, producing a thick, frothy residue that had to be got rid of before the patient could recover. For this reason the preferred treatments for fever were bleeding or purging, or both. Tertian ague, which produced both the shivers and a very high fever, with nothing else to show for it – no vomiting or diarrhoea – was an extreme example of the blood fermenting. Yet patients (and their doctors) were supposed to believe that Peruvian bark, which was said to cure the fever, did so without producing any residue. How, a Galenist would ask, could this be so?

  The study of natural history grew increasingly fashionable in England in the second half of the seventeenth century, and the gentlemen of the court vied to impress one another with what they knew. One session of the Royal Society in 1683 examined, in turn, the composition of chyle, widely considered to be the life-blood from which all human beings were made, the Arabic alphabet, the anatomy of the rattlesnake, the smell and colour of wine, and conducted a dissection of the genitals of a wild boar (‘The penis was three-quarters of a yard long, crooked towards the end, winding about like a wimble,’ wrote John Evelyn, the diarist, who attended the meeting). Despite an enthusiasm for the novel, the medical profession in England in the middle and late seventeenth century was deeply conservative, and still strictly Galenist.